Congress and an Exemption from ‘Obamacare’?

Q: Is it true that there are bills in Congress that would exempt members and their staffs and families from buying into “Obamacare”?

A: No. Congress members and staffers will be required to buy insurance through the exchanges on Jan. 1.

FULL QUESTION

Is it true that there are bills in the House and Senate that will exempt members and their staff and families from buying into Obamacare?

FULL ANSWER

Several readers have asked us about Congress attempting to exempt itself from the requirements of the Affordable Care Act. A few said that a Facebook post claimed that President Barack Obama, Sen. Harry Reid and Democrats in Congress were trying to “get themselves exempted from Obamacare,” in the words of one reader.

But there is no bill in Congress calling for an exemption from the health care law. In fact, members of Congress and their staffs face additional requirements that most Americans don’t have to meet.

Under the health care law, their insurance coverage will have to switch from the Federal Employees Health Benefits Program, the group of private insurance plans that cover 8 million federal employees and retirees, to the exchanges created by the law. Those exchanges are meant for those who buy coverage on their own, the currently uninsured and small businesses. Members of Congress and their staffs would be the only employees of a large employer in the exchanges, which are set to begin offering insurance in January.

So, why is the false “exempt” claim making the Facebook rounds? There is reportedly concern on Capitol Hill that the Office of Personnel Management, which administers the Federal Employees Health Benefits Program, won’t be able to smoothly transition members and their staffs into an exchange. The concern, as a Roll Call story explained, was that the government wouldn’t be able to make contributions toward the federal employees’ premiums, at least at the beginning of 2014. That would mean employees would pick up the whole tab for their insurance policies. Right now, the government pays 72 percent of premiums on average.

The “exempt” claims were sparked by a Politico report on April 24 that said secret talks were being held by lawmakers to change the requirement to get insurance through the exchanges because of this concern. The headline on the story said “Lawmakers, aides may get Obamacare exemption.”

After the story was published, a spokesman for Sen. Harry Reid said there hadn’t been any discussions to exempt Congress from “provisions that apply to any employees of any other public or private employer offering health care.” And Democratic Rep. Henry Waxman of California told Politico that lawmakers and their staffs will indeed get insurance through the exchanges. “[T]he federal government will offer them health insurance coverage that they obtained through the exchanges because we want to get the same health care coverage everybody else has available to them,” he said.

We contacted the Office of Personnel Management and received this statement from an administration official: “Members of Congress will not receive anything that is not available to the public. The law doesn’t allow them to get insurance from FEHB, they are going to get insurance on the market place, just like uninsured individuals and small businesses.”

We can’t say what did or didn’t happen in any secret meetings. But we can say that no bill has been introduced to exempt members of Congress from the Affordable Care Act — and they were never exempt in the first place. Even if, hypothetically, Congress were to nullify the provision requiring members and their staffs to get insurance on the exchanges, it still wouldn’t amount to an exemption from the law. Lawmakers and staffers would be subject to the mandate to have health insurance or pay a fine, just as everyone else is.

The law provides a few exemptions from the requirement to have insurance, but only for those who earn too little to file taxes, those with financial hardships, those who can’t find affordable coverage, and some religious groups that qualify for Social Security exemptions, mainly Mennonite or Amish.

An Old Falsehood

Bogus claims about Congress being “exempt” date back to early 2010, when different health care bills were still being debated. Some Republicans claimed that Americans, except for members of Congress, would be forced into the government-run “public option” (which wasn’t part of the final bill that became law) or state-based exchanges (which are part of the law).

As we said previously, members of Congress get private health insurance through the Federal Employees Health Benefits Program, which actually served as a model for the exchanges. Federal workers pick from among many health plans. The exchanges would operate in the same way — like a marketplace for those shopping for private insurance.

But some Republicans pushed the idea that if the exchanges were good enough for other Americans, they should be good enough for Congress. So, an amendment by Republican Sen. Chuck Grassley of Iowa was added to the Senate bill requiring that the federal government offer only health plans that were part of an exchange to members of Congress and their staffs. The law’s final language on this, written by Sen. Tom Coburn, says that: “the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are — (I) created under this Act (or an amendment made by this Act); or (II) offered through an Exchange established under this Act.”

Congressional “staff” is defined as “all full-time and part-time employees employed by the official office of a Member of Congress, whether in Washington, DC or outside of Washington, DC.” As we reported before, Coburn said the provision wouldn’t apply to those working for committees or leadership staff, and a Congressional Research Service report agreed that could be the case.

In other words, the Affordable Care Act places on lawmakers and their staffs additional requirements that don’t pertain to other Americans with work-based insurance.

Update, Aug. 7, 2013: The Office of Personnel Management issued a proposed rule on Aug. 7 explaining that members of Congress and applicable congressional staff will be required to purchase health insurance coverage through the exchanges created by the law. However, according to the proposed rule, the federal government, as the employer, will still be able to make a contribution to health insurance premiums as it currently does. The contribution will be no greater than that now offered to members and their staffs under the FEHB program, and members and their staffs will not be eligible for premium tax credits made available to other persons purchasing health insurance through the exchanges.